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‘The situation in Japan is not one that allows very talented women to flourish’

Tokyo • Revelations that a medical school in Tokyo systematically excluded female students in favour of less qualified men shocked the world. Yet, in Japan, few expect anything to change any time soon.

From stubborn gender roles, to a hard-driving work culture, to the ballooning healthcare needs of a rapidly ageing society, many of Japan’s most intractable woes were put on display at Tokyo Medical University.

The university acknowledged earlier this month it had manipulated test scores to ensure women remain a minority of its student body because it was concerned brutal work hours might prompt them to leave the workforce.

Government data show they have a point: Fewer than three quarters of female doctors are working 12 years after qualifying as physicians, compared to almost 90% of men.

The burden of the world’s oldest population has combined with Japan’s fixation on long hours and an indifference to wasting female talent, forming a toxic prescription that has hampered women’s career prospects, as well as improvements in productivity and living standards in Japan.

The government has launched a nationwide review of admission procedures at medical schools.

Unearthing the scandal could signal the start of a cultural shift, said Takuji Okubo, chief economist at Japan Macro Advisors in Tokyo, though he cautioned that the change would take considerable political will.

“Maybe people are starting to actually feel what they were doing was wrong, because of this general pressure to have a more equal status between males and females,” Okubo said.

He added that Japan is still a long way from how it should be. “It will still take significant political leadership — it’s going to take a few decades at the current pace.”

Not Enough

Concern about Japan’s shrinking workforce and ageing demographics has prompted Abe to try to lower the barriers keeping women from contributing fully to the economy.

His patchwork of measures has been criticised for not going far enough and he has shown little indication of a course correction as he campaigns for another three-year term as PM.

Abe introduced legislation this year limiting overtime and trying to narrow the gulf between treatment of full- and part-time workers, a role women are often pushed into. He has vowed to enable anyone to work if they want — regardless of age, disability or family responsibilities.

The effect so far has been limited; the Nikkei newspaper reported that overtime restrictions won’t take effect in the medical profession until 2024.

Kumiko Karasawa, dean of the School of Medicine at Tokyo Women’s Medical University, pointed to inhumane working practices and schedules as the root of the problem.

“In medicine, there is this idea that if you don’t work long, hard hours, you are a bad doctor,” she said.

“For example, if you are pregnant or giving birth and want to take time off or need to go home to take care of your kids, you are considered no good as a doctor.”

He also announced a survey of admissions procedures at all of Japan’s 81 medical schools, who were expected to report back last Friday.

Government data has long indicated that male applicants tacitly receive priority for entry to some medical schools.

The proportion of female medical students in Japan swelled dramatically between the 1970s and the 1990s, only to level off at about one-third — which is where it has been stuck for two decades. That’s despite the fact that female applicants are more likely than men to succeed at college applications in general.

‘Keep Women Out’

A study published by the Nikkei yesterday found that men were more likely than women to pass entrance tests at three quarters of Japan’s medical schools.

At some universities, women were less than half as likely as men to pass second-round tests, which include essays and interviews, the newspaper said.

“It’s been rumored that the system is rigged to keep women out,” said Asami Kawakami, a fifth-year medical student from Osaka, who said the scandal prompted her to consider studying overseas.

“I don’t think our society wants women to be in a position to give orders.”

Only about 20% of Japan’s doctors are women, compared to an average of 46% across member countries of the Organisation for Economic Cooperation and Development (OECD), 34% in the US and more than 70% in Latvia.

Aside from the burden on physicians, Japan’s addiction to long working hours plays into demand for medical services, according to Naoto Ueyama of Zenkoku Ishi Union, a labour union for physicians. Workers who feel compelled to minimise time off tend to demand treatment for ailments that could be cured by an extra day in bed.

The result is that Japanese on average have almost 13 visits to the doc- tor a year, compared to seven in Italy, for instance, placing an unnecessary burden on a healthcare sector that’s already being pushed to its limits by the greying population and has fewer physicians per capita than other advanced countries.

Encouraging women’s rise in the professions has been part of Abe’s prescription for stemming the labour shortage. Yet, his policies haven’t moved the needle much.

“The situation in Japan is not one that allows very talented women to flourish,” said Shigeru Ishiba, who is running against Abe for leadership of the ruling Liberal Democratic Party in a ballot next month. “That’s one of the most important problems facing the Japanese economy.”

While Japan’s labour force participation rate for women rose to 49.8% last year, compared to 46.2% in 2012, relatively few women are in supervisory positions.

Women still made up just 3.7% of directors of listed companies in 2017, for example, ranking toward the bottom of OECD countries.

Song Mihyon, a well-known female doctor and author of several books, said one solution should apply to both genders: Japan needs to make it easier for physicians to achieve a healthier work-life balance.

She opened her own clinic last year after finding it difficult to raise her two children amid overnight shifts at a hospital.

“Young male doctors see things quite differently from the older generation,” Song said.

“I often hear them say they are going home because it’s their turn to pick up the kids. Young people in general don’t want to work like slaves as the older generation expects.” — Bloomberg